This provider averages 55 services per working day
Based on 96.8K total services over 7 years (250 working days/year). Learn about impossible service volumes →
This provider's $16.3M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 55 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 3652% from 2017 to 2023.
72% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 465% in 2020
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2017 | $285.43 | $101.54 | 2.81x | $183.89 | $115.7K | 1.1K | 11 |
| 2018 | $335.43 | $116.33 | 2.88x | $219.10 | $444.4K | 3.8K | 18 |
| 2019 | $325.94 | $101.08 | 3.22x | $224.86 | $175.1K | 1.7K | 11 |
| 2020 | $821.23 | $260.39 | 3.15x | $560.84 | $989.5K | 3.8K | 16 |
| 2021 | $860.93 | $284.21 | 3.03x | $576.72 | $4.9M | 17.4K | 21 |
| 2022 | $667.08 | $206.80 | 3.23x | $460.28 | $5.3M | 25.7K | 23 |
| 2023 | $347.28 | $100.26 | 3.46x | $247.02 | $4.3M | 43.3K | 19 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 16.3K | $11.7M | $720.08 | 2.70x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 40.0K | $1.2M | $29.23 | 3.76x |
| 67028 | Injection of drug into eye | 9.6K | $835.0K | $86.80 | 8.69x |
| J2778 | Injection, ranibizumab, 0.1 mg | 2.6K | $638.4K | $246.21 | 3.24x |
| J3590 | Unclassified biologics | 851 | $403.2K | $473.74 | 2.80x |
| 92134 | Imaging of retina | 12.5K | $380.3K | $30.33 | 3.87x |
| 92014 | Established patient complete exam of visual system | 1.7K | $153.1K | $91.69 | 3.13x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.3K | $149.9K | $117.02 | 2.40x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.5K | $132.0K | $86.30 | 3.23x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 511 | $80.9K | $158.39 | 2.45x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 86 | $74.6K | $867.68 | 6.88x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.2K | $72.9K | $61.34 | 2.38x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 104 | $68.5K | $659.01 | 6.49x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 882 | $65.0K | $73.75 | 2.59x |
| 92250 | Photography of the retina | 2.0K | $60.3K | $29.85 | 5.99x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 1.4K | $51.3K | $37.77 | 2.86x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 59 | $50.4K | $853.92 | 5.89x |
| 67041 | Removal of membrane of retina | 46 | $39.0K | $847.21 | 4.61x |
| J9035 | Injection, bevacizumab, 10 mg | 514 | $29.4K | $57.29 | 1.67x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 382 | $26.9K | $70.41 | 3.17x |
This provider submits charges 3.21 times higher than what Medicare actually pays.
A markup ratio of 3.21x means for every $100 Medicare pays, this provider initially charges $321. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Ophthalmology providers in IN for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Drew Sommerville, MD | Evansville, IN | $35.4M | ✓ Clear |
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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